You are seeing this message because your Web browser does not support basic Web standards. Find out more about why this message is appearing and what you can do to make your experience on this site better.


ABOUT JAMA
Advanced Search

Welcome   | My Account | E-mail Alerts | Access Rights | Sign In


  Vol. 276 No. 23, December 18, 1996 TABLE OF CONTENTS
  JAMA
  •  Online Features
  ARTICLE
 This Article
 •Send to a friend
 • Save in My Folder
 •Save to citation manager
 •Permissions
 Citing Articles
 •Citation map
 •Citing articles on HighWire
 •Contact me when this article is cited
 Related Content
 •Similar articles in JAMA

Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension. Systolic Hypertension in the Elderly Program Cooperative Research Group

J. D. Curb, S. L. Pressel, J. A. Cutler, P. J. Savage, W. B. Applegate, H. Black, G. Camel, B. R. Davis, P. H. Frost, N. Gonzalez, G. Guthrie, A. Oberman, G. H. Rutan and J. Stamler
John A. Burns School of Medicine, Honolulu, Hawaii, USA.

OBJECTIVE: To assess the effect of low-dose, diuretic-based antihypertensive treatment on major cardiovascular disease (CVD) event rates in older, non-insulin-treated diabetic patients with isolated systolic hypertension (ISH), compared with nondiabetic patients. DESIGN: Double-blind, randomized, placebo-controlled trial: the Systolic Hypertension in the Elderly Program (SHEP). SETTING: Multiple clinical and support centers in the United States. PARTICIPANTS: A total of 4736 men and women aged 60 years and older at baseline with ISH (systolic blood pressure [BP], > or = 160 mm Hg; diastolic BP, <90 mm Hg) at baseline, 583 non-insulin-dependent diabetic patients and 4149 nondiabetic patients (4 additional patients not so classifiable were randomized but not included in these analyses). Diabetes mellitus defined as physician diagnosis, taking oral hypoglycemic drugs, fasting glucose level of 7.8 mmol/L or more (> or = 140 mg/dL), or any combination of these characteristics. INTERVENTION: The active treatment group received a low dose of chlorthalidone (12.5-25.0 mg/d) with a step-up to atenolol (25.0-50.0 mg/d) or reserpine (0.05-0.10 mg/d) if needed. The placebo group received placebo and any active antihypertensive drugs prescribed by patient's private physician for persistently high BP. MAIN OUTCOME MEASURES: The 5-year rates of major CVD events, nonfatal plus fatal stroke, nonfatal myocardial infarction (MI) and fatal coronary heart disease (CHD), major CHD events, and all-cause mortality. RESULTS: The SHEP antihypertensive drug regimen lowered BP of both diabetic and nondiabetic patients, with few adverse effects. For both diabetic and nondiabetic patients, all outcome rates were lower for participants randomized to the active treatment group than for those randomized to the placebo group. Thus, 5-year major CVD rate was lower by 34% for active treatment compared with placebo, both for diabetic patients (95% confidence interval [CI], 6%-54%) and nondiabetic patients (95% CI, 21%-45%). Absolute risk reduction with active treatment compared with placebo was twice as great for diabetic vs nondiabetic patients (101/1000 vs 51/1000 randomized participants at the 5-year follow-up), reflecting the higher risk of diabetic patients. CONCLUSION: Low-dose diuretic-based (chlorthalidone) treatment is effective in preventing major CVD events, cerebral and cardiac, in both non-insulin-treated diabetic and nondiabetic older patients with ISH.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Cardiovascular Risk Education and Social Support (CaRESS): Report of a Randomized Controlled Trial from the Kentucky Ambulatory Network (KAN)
Pearce et al.
J Am Board Fam Med 2008;21:269-281.
ABSTRACT | FULL TEXT  

Performance of Comorbidity Measures to Predict Stroke and Death in a Community-Dwelling, Hypertensive Medicaid Population
Tang et al.
Stroke 2008;39:1938-1944.
ABSTRACT | FULL TEXT  

Thiazide-Induced Dysglycemia: Call for Research From a Working Group From the National Heart, Lung, and Blood Institute
Carter et al.
Hypertension 2008;52:30-36.
FULL TEXT  

Screening for Type 2 Diabetes Mellitus in Adults: U.S. Preventive Services Task Force Recommendation Statement
U.S. Preventive Services Task Force
ANN INTERN MED 2008;148:846-854.
ABSTRACT | FULL TEXT  

Effect of Board Certification on Antihypertensive Treatment Intensification in Patients With Diabetes Mellitus
Turchin et al.
Circulation 2008;117:623-628.
ABSTRACT | FULL TEXT  

Hyperresistinemia Is Associated With Coexistence of Hypertension and Type 2 Diabetes
Takata et al.
Hypertension 2008;51:534-539.
ABSTRACT | FULL TEXT  

Standards of Medical Care in Diabetes--2008
American Diabetes Association
Diabetes Care 2008;31:S12-S54.
FULL TEXT  

Considerations for the Pharmacological Treatment of Diabetes in Older Adults
Odegard et al.
Diabetes Spectr. 2007;20:239-247.
FULL TEXT  

Understanding the Quality Chasm for Hypertension Control in Diabetes: A Structured Review of "Co-maneuvers" Used in Clinical Trials
Naik et al.
J Am Board Fam Med 2007;20:469-478.
ABSTRACT | FULL TEXT  

Race and Ethnicity in Trials of Antihypertensive Therapy to Prevent Cardiovascular Outcomes: A Systematic Review
Park and Taylor
Ann Fam Med 2007;5:444-452.
ABSTRACT | FULL TEXT  

Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: full text: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD)
Authors/Task Force Members et al.
Eur Heart J Suppl 2007;9:C3-C74.
FULL TEXT  

Increasing Cardiovascular Disease Burden Due to Diabetes Mellitus: The Framingham Heart Study
Fox et al.
Circulation 2007;115:1544-1550.
ABSTRACT | FULL TEXT  

Blood pressure and ageing
Pinto
Postgrad. Med. J. 2007;83:109-114.
ABSTRACT | FULL TEXT  

Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary: The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD)
Authors/Task Force Members et al.
Eur Heart J 2007;28:88-136.
FULL TEXT  

Prevalence, Awareness, Treatment, and Control of Hypertension Among United States Adults 1999-2004
Ong et al.
Hypertension 2007;49:69-75.
ABSTRACT | FULL TEXT  

The Cardiovascular Disease Continuum Validated: Clinical Evidence of Improved Patient Outcomes: Part I: Pathophysiology and Clinical Trial Evidence (Risk Factors Through Stable Coronary Artery Disease)
Dzau et al.
Circulation 2006;114:2850-2870.
FULL TEXT  

Action or Inaction? Decision Making in Patients With Diabetes and Elevated Blood Pressure in Primary Care
Hicks et al.
Diabetes Care 2006;29:2580-2585.
ABSTRACT | FULL TEXT  

Fasting Glucose Levels and Incident Diabetes Mellitus in Older Nondiabetic Adults Randomized to Receive 3 Different Classes of Antihypertensive Treatment: A Report From the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).
Barzilay et al.
Arch Intern Med 2006;166:2191-2201.
ABSTRACT | FULL TEXT  

Primary Prevention of Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline.
Goldstein et al.
Circulation 2006;113:e873-e923.
ABSTRACT | FULL TEXT  

Impaired Glucose Tolerance Increases Stroke Risk in Nondiabetic Patients With Transient Ischemic Attack or Minor Ischemic Stroke
Vermeer et al.
Stroke 2006;37:1413-1417.
ABSTRACT | FULL TEXT  

Primary Prevention of Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline.
Goldstein et al.
Stroke 2006;37:1583-1633.
ABSTRACT | FULL TEXT  

Antihypertensive Therapy and the Risk of New-Onset Diabetes
Sarafidis and Bakris
Diabetes Care 2006;29:1167-1169.
FULL TEXT  

Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline.
Sacco et al.
Circulation 2006;113:e409-e449.
ABSTRACT | FULL TEXT  

Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline.
Sacco et al.
Stroke 2006;37:577-617.
ABSTRACT | FULL TEXT  

Management of Hypertension in Diabetes
Stults and Jones
Diabetes Spectr. 2006;19:25-31.
ABSTRACT | FULL TEXT  

JBS 2: Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice
Prepared by: British Cardiac Society, British Hype
Heart 2005;91:v1-v52.
FULL TEXT  

Review: Blood pressure reduction in the metabolic syndrome and type 2 diabetes: current concepts
Schachter
British Journal of Diabetes & Vascular Disease 2005;5:320-324.
ABSTRACT  

Antihypertensive Agents for Primary Prevention of Diabetic Nephropathy
Strippoli et al.
J. Am. Soc. Nephrol. 2005;16:3081-3091.
ABSTRACT | FULL TEXT  

Clinical Outcomes in Antihypertensive Treatment of Type 2 Diabetes, Impaired Fasting Glucose Concentration, and Normoglycemia: Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)
Whelton et al.
Arch Intern Med 2005;165:1401-1409.
ABSTRACT | FULL TEXT  

Hypertension in type 2 diabetes - targeting angiotensin
DTB 2005;43:41-45.
ABSTRACT | FULL TEXT  

The cost of glucocorticoid-associated adverse events in rheumatoid arthritis
Pisu et al.
Rheumatology (Oxford) 2005;44:781-788.
ABSTRACT | FULL TEXT  

The Gender-Specific Impact of Diabetes and Myocardial Infarction at Baseline and During Follow-Up on Mortality From All Causes and Coronary Heart Disease
Hu et al.
J Am Coll Cardiol 2005;45:1413-1418.
ABSTRACT | FULL TEXT  

The European Association for the Study of Diabetes
Bloomgarden
Diabetes Care 2005;28:1250-1257.
FULL TEXT  

Cardiovascular morbidity and mortality in hypertensive patients with a history of atrial fibrillation: The Losartan Intervention For End point reduction in hypertension (LIFE) study
Wachtell et al.
J Am Coll Cardiol 2005;45:705-711.
ABSTRACT | FULL TEXT  

Prevention and Treatment of Diabetic Nephropathy: The Program for Irbesartan Mortality and Morbidity Evaluation
Ravera et al.
J. Am. Soc. Nephrol. 2005;16:S48-S52.
ABSTRACT | FULL TEXT  

The Effects of Cyclooxygenase-2 Inhibitors and Nonsteroidal Anti-inflammatory Therapy on 24-Hour Blood Pressure in Patients With Hypertension, Osteoarthritis, and Type 2 Diabetes Mellitus
Sowers et al.
Arch Intern Med 2005;165:161-168.
ABSTRACT | FULL TEXT  

Intensive Integrated Therapy of Type 2 Diabetes: Implications for Long-Term Prognosis
Gaede and Pedersen
Diabetes 2004;53:S39-S47.
ABSTRACT | FULL TEXT  

Trends in Cardiovascular Complications of Diabetes
Fox et al.
JAMA 2004;292:2495-2499.
ABSTRACT | FULL TEXT  

Treatment of Hypertension in Patients With Diabetes
Sowers
Arch Intern Med 2004;164:1850-1857.
ABSTRACT | FULL TEXT  

Ragaglitazar Improves Glycemic Control and Lipid Profile in Type 2 Diabetic Subjects: A 12-week, double-blind, placebo-controlled dose-ranging study with an open pioglitazone arm
Saad et al.
Diabetes Care 2004;27:1324-1329.
ABSTRACT | FULL TEXT  

The Impact of Vitamins and/or Mineral Supplementation on Blood Pressure in Type 2 Diabetes
Farvid et al.
J. Am. Coll. Nutr. 2004;23:272-279.
ABSTRACT | FULL TEXT  

Trends in Complexity of Diabetes Care in the United States From 1991 to 2000
Grant et al.
Arch Intern Med 2004;164:1134-1139.
ABSTRACT | FULL TEXT  

Women and Heart Disease: The Role of Diabetes and Hyperglycemia
Barrett-Connor et al.
Arch Intern Med 2004;164:934-942.
ABSTRACT | FULL TEXT  

Epidemiology of Diabetes
Winer and Sowers
J Clin Pharmacol 2004;44:397-405.
ABSTRACT | FULL TEXT  

Hypertension Management in the Diabetes Patient
Durst and Schering
Journal of Pharmacy Practice 2004;17:55-60.
ABSTRACT  

Optimizing Therapy in the Diabetic Patient with Renal Disease: Antihypertensive Treatment
Deferrari et al.
J. Am. Soc. Nephrol. 2004;15:S6-11.
ABSTRACT | FULL TEXT  

Hypertension Control: How Well Are We Doing?
Borzecki et al.
Arch Intern Med 2003;163:2705-2711.
ABSTRACT | FULL TEXT  

Increased Incidence of Coronary Atherosclerosis in Type 2 Diabetes Mellitus: Mechanisms and Management
Hurst and Lee
ANN INTERN MED 2003;139:824-834.
ABSTRACT | FULL TEXT  

Ragaglitazar: The Pharmacokinetics, Pharmacodynamics, and Tolerability of a Novel Dual PPAR{alpha} and {gamma} Agonist in Healthy Subjects and Patients with Type 2 Diabetes
Skrumsager et al.
J Clin Pharmacol 2003;43:1244-1256.
ABSTRACT | FULL TEXT  

The JNC 7 Hypertension Guidelines
Murthy
JAMA 2003;290:1313-1313.
FULL TEXT  

Effects of Blood Pressure Level on Progression of Diabetic Nephropathy: Results From the RENAAL Study
Bakris et al.
Arch Intern Med 2003;163:1555-1565.
ABSTRACT | FULL TEXT  

Blood pressure measurement in diabetes: theory and practice
Petrie
British Journal of Diabetes & Vascular Disease 2003;3:258-261.
ABSTRACT  

Commonly asked questions: hypertension
Petrie and Kirby
British Journal of Diabetes & Vascular Disease 2003;3:270-273.
 

The ALLHAT Study
Goff
Clin. Diabetes 2003;21:102-104.
FULL TEXT  

Prevention of Hypertension and Its Complications: Theoretical Basis and Guidelines for Treatment
Flack et al.
J. Am. Soc. Nephrol. 2003;14:S92-98.
ABSTRACT | FULL TEXT  

The Evidence Base for Tight Blood Pressure Control in the Management of Type 2 Diabetes Mellitus
Snow et al.
ANN INTERN MED 2003;138:587-592.
ABSTRACT | FULL TEXT  

Treatment of Hypertension in Type 2 Diabetes Mellitus: Blood Pressure Goals, Choice of Agents, and Setting Priorities in Diabetes Care
Vijan and Hayward
ANN INTERN MED 2003;138:593-602.
ABSTRACT | FULL TEXT  

Outcome beyond blood pressure control?
Staessen et al.
Eur Heart J 2003;24:504-514.
FULL TEXT  

Prospective Analysis of Mortality, Morbidity, and Risk Factors in Elderly Diabetic Subjects: Nagano Study
Katakura et al.
Diabetes Care 2003;26:638-644.
ABSTRACT | FULL TEXT  

Hypertension Management in Patients With Diabetes: The need for more aggressive therapy
Berlowitz et al.
Diabetes Care 2003;26:355-359.
ABSTRACT | FULL TEXT  

Multifactorial Intervention and Cardiovascular Disease in Patients with Type 2 Diabetes
Gaede et al.
NEJM 2003;348:383-393.
ABSTRACT | FULL TEXT  

Cardiovascular Disease in Type 2 Diabetes Mellitus: Current Management Guidelines
Mooradian
Arch Intern Med 2003;163:33-40.
ABSTRACT | FULL TEXT  

Diabetology for cardiologists
Laakso and Kuusisto
Eur Heart J Suppl 2003;5:B5-B13.
ABSTRACT  

Prevention of macrovascular complications
Fisher
Eur Heart J Suppl 2003;5:B21-B26.
ABSTRACT  

Renal and Cardiovascular Protection in Type 2 Diabetes Mellitus: Angiotensin II Receptor Blockers
Deferrari et al.
J. Am. Soc. Nephrol. 2002;13:S224-229.
ABSTRACT | FULL TEXT  

Common Drug Pathways and Interactions
Kroner
Diabetes Spectr. 2002;15:249-255.
ABSTRACT | FULL TEXT  

Tests of Glycemia for the Diagnosis of Type 2 Diabetes Mellitus
Barr et al.
ANN INTERN MED 2002;137:263-272.
ABSTRACT | FULL TEXT  

The Impact of Clinical Trials on the Treatment of Diabetes Mellitus
Nathan
J. Clin. Endocrinol. Metab. 2002;87:1929-1937.
ABSTRACT | FULL TEXT  

Special management needs of the elderly hypertensive patient
Elliott and McInnes
Journal of Renin-Angiotensin-Aldosterone System 2002;3:S25-S31.
 

Therapy in the elderly hypertensive
Meredith and Trenkwalder
Journal of Renin-Angiotensin-Aldosterone System 2002;3:S49-S56.
ABSTRACT  

Management of Hypertension in Patients with Type 2 Diabetes Mellitus: Guidelines Based on Current Evidence
Kaplan
ANN INTERN MED 2001;135:1079-1083.
ABSTRACT | FULL TEXT  

Reduced Cardiovascular Morbidity and Mortality in Hypertensive Diabetic Patients on First-Line Therapy With an ACE Inhibitor Compared With a Diuretic/{beta}-Blocker-Based Treatment Regimen: A subanalysis of the Captopril Prevention Project
Niskanen et al.
Diabetes Care 2001;24:2091-2096.
ABSTRACT | FULL TEXT  

Vascular complications in diabetes and their prevention
Kassab et al.
Vasc Med 2001;6:249-255.
ABSTRACT  

Randomised controlled trial of structured personal care of type 2 diabetes mellitus
Olivarius et al.
BMJ 2001;323:970-970.
ABSTRACT | FULL TEXT  

Treatment of Isolated Systolic Hypertension Is Most Effective in Older Patients With High-Risk Profile
Ferrucci et al.
Circulation 2001;104:1923-1926.
ABSTRACT | FULL TEXT  

The Diabetes Quality Improvement Project: Moving science into health policy to gain an edge on the diabetes epidemic
Fleming et al.
Diabetes Care 2001;24:1815-1820.
FULL TEXT  

Renoprotective Effect of the Angiotensin-Receptor Antagonist Irbesartan in Patients with Nephropathy Due to Type 2 Diabetes
Lewis et al.
NEJM 2001;345:851-860.
ABSTRACT | FULL TEXT  

Developing a Prediction Rule From Automated Clinical Databases to Identify High-Risk Patients in a Large Population With Diabetes
Selby et al.
Diabetes Care 2001;24:1547-1555.
ABSTRACT | FULL TEXT  

Blood Pressure Control and Benefits of Antihypertensive Therapy: Does It Make a Difference Which Agents We Use?
Ruilope and Schiffrin
Hypertension 2001;38:537-542.
ABSTRACT | FULL TEXT  

Treatment of Obesity Hypertension and Diabetes Syndrome
Zanella et al.
Hypertension 2001;38:705-708.
ABSTRACT | FULL TEXT  

The American Diabetes Association's 48th Annual Advanced Postgraduate Course
Bloomgarden
Diabetes Care 2001;24:1489-1495.
FULL TEXT  

Silent and clinically overt stroke in older Japanese subjects with white-coat and sustained hypertension
Kario et al.
J Am Coll Cardiol 2001;38:238-245.
ABSTRACT | FULL TEXT  

Baseline Characteristics of the Diabetic Participants in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)
Barzilay et al.
Diabetes Care 2001;24:654-658.
ABSTRACT | FULL TEXT  

Diabetes, Hypertension, and Cardiovascular Disease : An Update
Sowers et al.
Hypertension 2001;37:1053-1059.
ABSTRACT | FULL TEXT  

Inferiority of calcium channel blockers to cheaper drugs
Kaplan et al.
BMJ 2001;322:671a-671.
FULL TEXT  

Review: The management of the elderly with hypertension
Bulpitt
Journal of Renin-Angiotensin-Aldosterone System 2001;2:11-13.
 

Primary Prevention of Ischemic Stroke : A Statement for Healthcare Professionals From the Stroke Council of the American Heart Association
Goldstein et al.
Circulation 2001;103:163-182.
FULL TEXT  

Diabetes in Elderly Adults
Meneilly and Tessier
J. Gerontol. A Biol. Sci. Med. Sci. 2001;56:5M-13.
ABSTRACT | FULL TEXT  

Primary Prevention of Ischemic Stroke : A Statement for Healthcare Professionals From the Stroke Council of the American Heart Association
Goldstein et al.
Stroke 2001;32:280-299.
FULL TEXT  

What Is the Best Evidence for Making Clinical Decisions?
Shah et al.
JAMA 2000;284:3127-3128.
FULL TEXT  

Variations in the Care of Elderly Persons With Diabetes Among Endocrinologists, General Internists, and Geriatricians
Chin et al.
J. Gerontol. A Biol. Sci. Med. Sci. 2000;55:601M-606.
ABSTRACT | FULL TEXT  

Managing cardiovascular risk in patients with diabetes
Rydén
Heart 2000;84:23i-25.
FULL TEXT  

Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study
Adler et al.
BMJ 2000;321:412-419.
ABSTRACT | FULL TEXT  

Choosing a first-line drug in the management of elevated blood pressure: What is the evidence? 1: Thiazide diuretics
Wright
CMAJ 2000;163:57-60.
ABSTRACT | FULL TEXT  

Optimizing Treatment of Hypertension in Patients With Diabetes
Cooper and Johnston
JAMA 2000;283:3177-3179.
FULL TEXT  

Hypertension and Diabetes: New Therapeutic Options
Deedwania
Arch Intern Med 2000;160:1585-1594.
ABSTRACT | FULL TEXT  

Cardiac, renal and vascular complications in the diabetic patient
Zanchetti
Journal of Renin-Angiotensin-Aldosterone System 2000;1:S21-S24.
ABSTRACT  





HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | SUBMIT | SUBSCRIBE | HELP
CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP
 
© 1996 American Medical Association. All Rights Reserved.